Andreas Kuchar

AIMS To determine the efficacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults. METHODS Balloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora. Obstruction was diagnosed by canalicular irrigation and transcanalicular endoscopic examination of the lacrimal pathway. Except for four cases in which general anaesthesia was applied, the procedure was performed under local anaesthesia. The Lacricath balloon catheter set was used. Silicone intubation was performed simultaneously. The time at which the tubes were removed depended on the findings at postoperative follow up but was, at the earliest, 3 months postoperatively. RESULTS Success was objectified by irrigation and was evaluated subjectively at each follow up examination according to Munk's scale. In all cases the procedure could be performed with subsequent silicone intubation. Three months postoperatively 89.9% of all cases were positive on simple irrigation, and subjective success was also registered (Munk's grade 0 or 1). At 6 months 70% of all cases were positive on irrigation, again with subjective success (Munk's grade 0 or 1). One year postoperatively 73.3% of all procedures showed subjective success (two successful redilatations would raise the success rate to 79.9%). CONCLUSION Retrograde as well as antegrade dilatation has been reported to be more or less successful in partial nasolacrimal obstruction. Although the procedure is used as primary treatment in cases of complete obstruction, it can still be performed under local anaesthesia on an outpatient basis. Long term observation will be required to prove the sustained effect of this procedure.

: Aims: To determine the current bacteriology of mucopurulent discharge in congenital nasolacrimal duct obstruction (CNDO), the in vitro response to different antibiotics and clinical effectiveness of the antibiotics used to relieve babies from mucopurulent discharge.Methods: A clinical study evaluated the effectiveness of local antibiotic agents clinically and in vitro. 50 samples were obtained from the lacrimal sac in 47 young children with CNDO. The patients' mean age was 21.45±17.09 months. The cultures were incubated and the infectious agents isolated. Sensitivity testing was performed in each case, testing 10 different local antibiotics. A control group of 10 babies expected for cataract surgery was constituted.Results: Cultures were positive for bacteria from 72.64% of the samples. 73 isolates were recovered from the 50 samples. The bacterial species most frequently cultured was Streptococcus pneumoniae, representing 35.4% of the isolates, followed by Haemophilus influencae (19.6%). The sensitivity testing revealed ofloxacin and tetracycline to be the most effective drugs as monotherapy. Clinically the combination of bacitracin and neomycin, primarily used in half of the patients as initial therapy, was successful in curing the dacryocystitis in 82.5% of all patients.Conclusion: Chronic dacryocystitis due to CNDO is associated with an equal proportion of Gram positive and negative bacteria, which can be treated with a high effectiveness by a combination drug of bacitracin and neomycin.

Blepharospasm is a dystonia of the orbicularis muscle. The background is still unknown, but it appears together with organic and psychic diseases. The therapy with botulinum toxine is symptomatically but efficient. Because of the relaxing effect on the psychological and autonomous nervous disorders we performed a pilot study with acupuncture. There was a neurological observation first, then a ophthalmologic examination of the ocular surface. Blepharospasm was measured by the Visual Analogue Scale (VAS), the social disorders by the Elston-Score. We performed acupuncture treatment 10 times once weekly. The used points were local points with higher sensitivity, and points with empiric relaxation effect. 5 patients were included. The mean of Elston score was 3 before acupuncture and 4 after acupuncture. The VAS increased from 33.3 to 69/100 points. But there were fluctuations of dystonias. In conclusion acupuncture maybe a good method for this difficult disease additionally.

An infection with Toxoplasma gondii during pregnancy means that the unborn baby may be infected as well. In addition to the risk that the baby may be born dead, central chorioretinitis could also occur. Pregnant women with primary infection were treated with spiramycin or a combination of pyrimethamine and sulfadiacine. A total of 153 children (1 month-1 year) were examined twice with particular attention to the macula region. Only two cases showed central retinochoroiditis. In one case the treatment was insufficient, and in the other the time between the serological examinations was too long. None of the other children showed any central pathological changes within the follow-up period. Screening methods, the appropriate treatment and the results are presented.